Abstract
The ability to reconstruct defects with free tissue has dramatically improved the outcomes of patients with deficits of the head and neck. These vascularized bone grafts (VBGs) have dramatically improved the potential for reconstruction of complex defects of the mandible and maxilla following tumor ablation or severe trauma. VBGs utilizing microvascular free tissue transfer are at the top of the reconstructive ladder, providing vascularized tissue to defects of substantial size or suboptimal conditions such as areas of radiation, infection, and implantation. These flaps may be used for defects in the maxilla and/or mandible, depending on the defect’s size, location, and local tissues required. Numerous donor sites for free bone flaps have been described for this application, including the fibula, iliac crest, scapula, rib, and radial forearm. In addition to a comprehensive discussion of each, current and future trends in the field, such as CAD-CAM imaging, robotic surgery, and tissue engineering, are described in the present chapter.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Banerjee AR, Westmore GA. Free rib graft reconstruction of the mandible: a forgotten option? Ann R Coll Surg Engl. 1995;77(4):278–82.
Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft: a clinical extension of microvascular techniques. Plast Reconstr Surg. 1975;55:533–44.
Buncke JH, Furnas DW, Gordon L, Achauer BM. Free osteo-cutaneous flap from a rib to the tibia. Plast Reconstr Surg. 1977;59:799–804.
McKee DM. Microvascular bone transplantation. Clin Plast Surg. 1978;5:283–92.
Berggren A, Weiland AJ, Dorfman H. Free vascularized bone grafts: factors affecting their survival and ability to heal to recipient bone defects. Plast Reconstr Surg. 1982;69:19–29.
Berggren A, Weiland AJ, Dorfman H. The effect of prolonged ischemia time on osteocyte and osteoblast survival in composite bone grafts revascularized by microvascular anastomoses. Plast Reconstr Surg. 1982;69:290–8.
Moore JB, Mazur JM, Zehr D, Davis PK, Zook EG. A biomechanical comparison of vascularized and conventional autogenous bone grafts. Plast Reconstr Surg. 1984;73:382–6.
Altobelli DE, Lorente CA, Handren JH, Young J, Donoff RB, May JW. Free and microvascular bone grafting in the irradiated dog mandible. J Oral Maxillofac Surg. 1987;45:27–33.
Schliephake H. Revascularized tissue transfer for the repair of complex midfacial defects in oncologic patients. J Oral Maxillofac Surg. 2000;58:1212–8.
Coleman JJ III. Osseous reconstruction of the midface and orbits. Clin Plast Surg. 1994;21:113–24.
McCarthy C, Cordeiro P. Microvascular reconstruction of oncologic defects of the face. Plast Reconstr Surg. 2010;126:1947–59.
Bianchi B, Ferri A, Ferrari S, Copelli C, Poli T, Sesenna E. Free and locoregional flap associations in the reconstruction of extensive head and neck defects. Int J Oral Maxillofac Surg. 2008;37(8):723–9.
Finseth F, Kavarana N, Antia N. Complications of free flap transfers to the mouth region. Plast Reconstr Surg. 1975;56:652–3.
Kim BC, Kim S, Nam W, Cha IH, Kim HJ. Mandibular reconstruction with vascularized osseous free flaps: a review of the literature. Asian Pac J Cancer Prev. 2012;13:553–8.
Miles B, Goldstein D, Gilbert R, Gullane P. Mandible reconstruction. Curr Opin Otolaryngol Head Heck Surg. 2010;18:317–22.
Foster RD, Anthoby JP, Sharma A, Pogral MA. Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcomes analysis of primary bone union and endosseous implant success. Head Neck. 1999;21:66–71.
Bodard AG, Salino S, Bemer J, Lucas R, Breton P. Dental implant placement after mandibular reconstruction by microvascular free fibula flap: current knowledge and remaining questions. Oral Oncol. 2011;47:1099–104.
Odin G, Balaquer T, Salvadelli C, Scortecci G. Immediate functional loading of implant-supported fixed prosthesis at the time of ablative surgery and mandibular reconstruction for squamous cell carcinoma. J Oral Implantol. 2010;36(3):225–30.
Disa J, Hidalgo D, Cordeiro P, Winter R, Thaler H. Evaluation of bone height in osseous free flap mandible reconstruction: an indirect measure of bone mass. Plast Reconstr Surg. 1999;103(5):1371–7.
Urken ML. Composite free flaps in oromandibular reconstruction. Arch Otolaryngol Head Neck Surg. 1994;120:633–40.
Weinberg H, Silver L, Chun JK. Current practice and future trends in craniomaxillofacial reconstructive and corrective microvascular bone surgery. In: Greenberg AM, Prein J, editors. Craniomaxillofacial Reconstructive and Corrective Bone Surgery. New York: Springer; 2002. p. 310–6.
Takushima A, Harii K, Asato H, Nakatsuka T, Kimata Y. Mandibular reconstruction using microvascular free flaps: a statistical analysis of 178 cases. Plast Reconstr Surg. 2001;108(6):1555–63.
Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989;115:339–49.
Jones NF, Swartz WM, Mears DC, Jupiter JB, Grossman A. The “double-barrel” free vascularized fibular bone graft. Plast Reconstr Surg. 1988;81:378–85.
Futran ND, Alsarraf R. Microvascular free-flap reconstruction in the head and neck. JAMA. 2000;284:1761–3.
Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex vessels as the supply for groin flaps. Plast Reconstr Surg. 1979;64(5):595–60.
Brown JS, Rogers SN, McNally DN, Boyle M. A modified classification for the maxillectomy defect. Head Neck. 2000;22:17–26.
Urken ML, Vickery CB, Weinberg H, et al. The interal oblique-iliac crest osseomyocutaneous free flap in oromandibular reconstruction. Report of 20 cases. Ach Otolaryngol Head Neck Surg. 1989;115:339–49.
Hartman EH, Spauwen PH, Jansen JA. Donor-site complications in vascularized bone flap surgery. J Investig Surg. 2002;15:185–97.
Swartz WM, Banis JC, Newton ED, Ramasastry SS, Johns NF, Acland R. The osteocutaneous scapular flap for mandibular and maxillary reconstruction. Plast Reconstr Surg. 1986;77:530–45.
Jedrzejewski P, Maciejewski A, Szymczyk C, Wierzgon J. Maxillary reconstruction using a multi-element free fibula flap based on a three-dimensional polyacrylic resin model. Pol Przegl Chir. 2012;84:49–55.
Frodel JL Jr, et al. Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps. Plast Reconstr Surg. 1993;92(3):449–55.
Genden E. Reconstruction of the mandible and maxilla: the evolution of surgical technique. Arch Facial Plast Surg. 2010;12(2):87–90.
Kim PD, Blackwell KE. Latissimus-serratus-rib free flap for oromandibular and maxillary reconstruction. Arch Otolaryngol Head Neck Surg. 2007;133(8):791–5.
Levine JP, et al. Computer-aided design and manufacturing in craniomaxillofacial surgery: the new state of the art. J Craniofac Surg. 2012;23(1):288–93.
Markiewicz MR, Bell RB. Modern concepts in computer-assisted craniomaxillofacial reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2011;19:295–301.
Cohen A, Laviv A, Berman P, et al. Mandibular reconstruction using stereolithographic 3-dimensional printing technology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:661–6.
Siemionow M, Ozer K, Siemionow W, Lister G. Robotic assistance in microsurgery. J Reconstr Microsurg. 2000;16(8):643–9.
Katz RD, Rosson GD, Taylor JA, Singh NK. Robotics in microsurgery: use of a robot arm to perform a free flap in a pig. Microsurgery. 2005;25(7):566–9.
Selber JC. Transoral robotic reconstruction of oropharyngeal defects: a case series. Plast Reconstr Surg. 2010;126:1978–87.
Selber JC. Robotic surgery (editorial). J Reconstr Microsurg. 2012;28(7):433–4.
Liu YF, Zhu FD, Dong XT, Peng W. Digital design of scaffold for mandibular defect repair based on tissue engineering. J Zhejiang Univ Sci B. 2011;12(9):769–79.
Zhang WB, Zheng LW, Chua DT, Cheung LK. Treatment of irradiated mandibles with mesenchymal stem cells transfected with bone morphogenic protein 2/7. Oral Maxillofac Surg. 2012;70(7):1711–6.
Castro-Govea Y, et al. Human bone morphogenic protein 2-transduced mesenchymal stem cells improve bone regeneration in a model of mandible distraction surgery. J Craniofac Surg. 2012;23(2):392–6.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Science+Business Media, LLC, part of Springer Nature
About this chapter
Cite this chapter
Taub, P.J., Yao, A.S. (2019). Microvascular Craniomaxillofacial Reconstructive Bone Surgery. In: Greenberg, A., Schmelzeisen, R. (eds) Craniomaxillofacial Reconstructive and Corrective Bone Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1529-3_25
Download citation
DOI: https://doi.org/10.1007/978-1-4939-1529-3_25
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-1528-6
Online ISBN: 978-1-4939-1529-3
eBook Packages: MedicineMedicine (R0)